Provider Demographics
NPI:1073594974
Name:HANDRUP, THEODORE B (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:B
Last Name:HANDRUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2800 N SHERIDAN RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6156
Mailing Address - Country:US
Mailing Address - Phone:773-472-1483
Mailing Address - Fax:773-472-1489
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 502
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-472-1483
Practice Address - Fax:773-472-1489
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12861Medicare UPIN
ILL36681Medicare PIN